Demographic, Clinical and Laboratory Characteristics of Atrial Fibrillation as Seen in Medical out-patient Clinics at the Kenyatta National Hospital
Abstract
ABSTRACT
Background
Atrial fibrillation (AF) is the Commonest sustained arrhythmia encountered in clinical
practice with frequent hospitalizations. In Sub-saharan Africa it is presumed to be
predominantly valvular.
Objective:
To determine Demographic, Clinical characteristics and treatment options utilised
Ambulatory Atrial Fibrillation (AF) .
Design: A descriptive case registry
Setting: Medical out-patients at a tertiary referral hospital: Kenyatta National Hospital,
Nairobi, Kenya
Subjects: Consecutive Medical Out-patient attendees
Methods:
Daily Case records perusal identified file label of AF from which demographic, clinical,
electrocardiographic and treatment data was extracted and a comprehensive clinical
evaluation and resting 12-lead ECG recorded.
Outcome Measures: Clinical cardiac diagnosis label, Treatment mordalities as rate or
rhythm control strategy, anti-thrombotic therapy utilized and anti-coagulation intensity and
monitoring over preceeding 6 months
Results:
Between 18thAugust and 14th November 7,608 files were perused and 211 AF cases
enrolled; mean age of 48 yrs.73% were under 65yrs, 68% female. Clinically diagnosed AF
had a period prevalence of -3%. AF was found to be predominantly non-valvular in
aetiology at 53%.lt was commonly associated with Hypertension at 54%.Rate control was
the commonest strategy in use at 83% and the vast majority of our patients were on
antithrombotic therapy (60% on Warfarin and 20% on Aspirin) this was similar in VHD and
NVHD. Majority of the patients were on 5mg of Warfarin, INR monitoring was only ,
perfomed 2.5 times in six months and INR range 1.5-8, Mean 2.5
Heart-failure was the commonest recorded complication of AF recorded in this study at
47% thrombo-embolic phenomena followed at 12% and major bleeding episodes 0.2%
and AF related hospitalization at 14%.
Conclusion:
AF is not uncommon in the ambulatory setting, mostly valvular in aetiology, being
adequately addressed in terms of rate-control and antithrombotic therapy. Intensity of
anticoagulation is adequate but it's monitoring is not. AF is complicated by heart failure
and thrombo-embolic episodes.
Publisher
University of Nairobi